Uterine embolization and postoperative pain management

Uterine embolization is increasingly used to treat uterine fibroids when circumstances allow; it offers a less invasive alternative to traditional surgical techniques such as hysterectomy. However, some patients are concerned about postoperative pain, which can be significant if not correctly managed. At the American Hospital of Paris, we use effective strategies to manage pain after a uterine embolization and ensure our patients remain comfortable.

Uterine embolization is a minimally invasive interventional radiology procedure frequently used to treat uterine fibroids, which are noncancerous tumors that grow in the uterus. Performed by an interventional radiologist under local anesthesia, the procedure consists in obstructing the arteries that supply blood to the fibroids by injecting tiny particles into them. This decreases their size and causes the associated symptoms to disappear (pelvic pain, abdominal swelling, heavy bleeding, etc.).

A less invasive alternative to traditional surgery (hysterectomy), uterine embolization requires neither a large incision nor the removal of the uterus, and therefore leaves no scar. Instead, a microcatheter is inserted into an artery in the groin and threaded to the uterine arteries in real time under x-ray guidance. Once the catheter is in place, embolization particles are injected into the arteries to block the flow of blood to the fibroids.

This procedure is generally performed under local anesthesia, on an outpatient basis or followed by a short hospital stay. This enables the patient to recover quickly and reduces the symptoms associated with the fibroids in the weeks following the embolization.

Uterine embolization offers many advantages compared to traditional surgical treatments, including faster recovery, lower risk of complications and, most importantly, the preservation of the uterus. However, the patient may experience significant postoperative pain, which must be managed appropriately.

Patients frequently feel pain after a uterine embolization, mainly due to tissue inflammation and uterine contractions resulting from the operation. That is why the American Hospital of Paris offers a range of strategies to ensure effective pain relief and an optimal recovery.

Hypogastric plexus block

We perform a hypogastric plexus block during the uterine embolization procedure. This technique, not yet widely used, involves injecting a local anesthetic around the nerves that carry signals about pain affecting the pelvic area. By blocking these pain signals, we are able to considerably reduce the pain patients experience after the procedure. This in turn improves their level of comfort and well-being throughout the healing process.

According to a meta-analysis conducted in 2023, hypogastric plexus blocks can effectively reduce pain after a uterine artery embolization performed to treat fibroids. Around 98.8% of patients were able to go home the day of the procedure, and only 6.9% had to be readmitted. The average pain score reported by patients who received a hypogastric plexus block was 3.4, compared to 4.3 for those who had not received one. In addition, nearly half of the patients did not need additional painkilling medication. These results suggest that hypogastric plexus block in an effective option for relieving pain after a uterine embolization, thereby improving patient comfort (1).

Intrathecal morphine

As of May 2024, the American Hospital of Paris is the only center that offers intrathecal morphine in addition to hypogastric plexus block. Intrathecal morphine is the administration of a regional anesthetic that blocks pain signals in the spinal cord. This technique offers lasting relief of postoperative pain without requiring a urinary catheter and increases patients’ comfort level during the recovery period. Furthermore, it reduces the need for postoperative analgesia, thereby reducing the risk of side effects resulting from such medications.

Monitoring and adjustment in real time

To ensure optimal pain management, we give patients the option of remaining hospitalized after the uterine embolization, rather than systematically performing the procedure on an outpatient basis. This allows us to monitor their pain in real time and to adjust the treatment as needed, at any time. Our team of anesthesiologists is on hand to attend to their needs and make sure they are as comfortable as possible during their recovery.

By combining these different approaches to managing pain after a uterine embolization, our aim is to provide a positive and reassuring treatment experience to our patients while ensuring their well-being and comfort throughout their care pathway.